_Modifications._--Dupuytren used to saw through the ulna, leaving the olecranon attached. Velpeau opposed this, but it is again recommended by Gross, who leaves the olecranon, and at the same time improves the shape of the stump by sawing off the "inner trochlea" on a level with the general surface. AMPUTATION OF THE ARM.--This amputation is best performed by double flap, and is the typical instance which exhibits all the advantages of two equal flaps made by transfixion, without any of the disadvantages of that method. These advantages are, easiness of performance, rapidity, excellent covering for the bone, with as little sacrifice of tissue as is possible, while the fact that the cicatrix is opposite the end of the bone is hardly a disadvantage in the arm (as it certainly is in the leg), as no weight has to be borne on it. When they can be obtained, anterior and posterior flaps are generally considered most satisfactory, but Mr. Spence prefers lateral ones, lest the line of union should be interfered with by the deltoid raising the bone. If the right arm has to be amputated, the operator standing at the inner side raises the anterior muscles with his left hand, and enters the knife just in front of the brachial vessels (Plate I. fig. 12); keeping as close as possible to the bone, he brings out the knife at a point exactly opposite, then with a brisk sawing motion, cuts a semicircular flap, taking care to bring out the knife more suddenly just at the end, in order to cut through the skin as perpendicularly to the arm as possible. The knife is again entered at the same point, carried behind the bone, and brought out at the same angle, and an exactly corresponding flap cut from the other side of the limb, the flaps are then retracted, the bone cleared by circular incision and sawn through as high up as it is exposed. In primary cases, where the muscles are firm and developed, the flaps should be cut a little concave. _Modifications and Varieties._--Teale's method may of course be used here as elsewhere. The internal line of incision (Plate IV. fig. 8) should be made just in front of the brachial vessels. This method requires the amputation to be performed higher up than would otherwise be necessary (from the length of the anterior flap), and this disadvantage is not counterbalanced by any special advantage in the posterior retraction of the cicatrix. In feeble flabby arms, the true circular operation is very easily performed, and with good results. A circular sweep of the knife is made through the skin alone, which is drawn up by an assistant, while the surgeon separates it from the fascia; another circular cut through fascia and muscles exposes the bone, which must then be cleared and cut through at a still higher level.